Supreme Court: A&E receptionists must give accurate information regarding waiting times

Background

On 17 May 2010, the Appellant attended Mayday Hospital’s A&E department after having been struck to the head during an assault. He ‘booked’ into reception, answered a series of questions and he alleged that the receptionist concerned informed him that he would have to wait for up to four to five hours to be seen by a doctor; this information was incorrect.

There were two receptionists on duty that day and neither recalled the incident and could only comment on their usual practice. One gave evidence that she would have advised the patient that he would usually be seen by a triage nurse within 30 minutes, given his report of a head injury and the other said she would have advised him that the triage nurse would assess him “as soon as possible”. Relying on the information that he would have to wait 4-5 hours, the Appellant left the hospital after only 19 minutes without treatment and his condition deteriorated. He returned to hospital via ambulance a short time later and underwent neurosurgery; unfortunately, it was too late to prevent brain damage and he suffered a left hemiplegia.

At first instance, the High Court dismissed the claim, although it made a series of findings relevant to the Supreme Court decision. The High Court had to determine whether the A&E reception staff owed a duty of care to the Appellant to provide accurate information regarding waiting times and whether there was a failure to assess the appellant for priority triage.

The trial judge found that this was not a case which required priority triage and that A&E receptionists were not under a duty to guard patients against harm caused by their failure to wait to be seen in A&E, even if such harm could have been prevented had accurate information been provided. The function of a receptionist was to complete registration forms and the provision of waiting time information was a courtesy, rather than an obligation. It was the Appellant’s decision to leave after 19 minutes without being seen and without informing the reception staff of his departure. The Court did however find that it was reasonably foreseeable that incorrectly advising a patient that they would not be seen for 4-5 hours could lead to harm.

The Appellant appealed the decision that the Trust’s duty did not extend to providing accurate waiting time information, however, this appeal was also dismissed by the Court of Appeal on the basis that:

• Neither the hospital or its reception staff owed the patient a duty to advise about waiting times;
• The damage/injury was outside the scope of the hospital’s breach of duty; and
• There was no causal link between the breach of duty and the injury.

The Court of Appeal said that a receptionist’s key duties included recording the details of new arrivals, directing them on where to wait and passing these details onto a triage nurse. They are not required at any point to provide any wider advice or information to patients. As such, it would not have been fair, just and reasonable to impose a duty of care on the receptionists as this would add an additional layer of responsibility to clerical staff, and lead to ‘undesirable consequences’.

The Supreme Court

On 10 October 2018, the Supreme Court handed down its unanimous judgment, allowing the appeal. In brief, it decided that:

• The case in question falls squarely within an established category of duty of care – it long having been established that those managing a casualty department owe a duty to persons who present themselves complaining of illness or injury;
• That duty is to take reasonable care not to cause physical injury to the patient which includes a duty not to provide misleading information;
• A failure to provide accurate information could foreseeably cause physical injury;
• In this regard, it is not appropriate to distinguish between medically and non-medically qualified staff;
• The Trust had charged its non-qualified staff (receptionists) to act as the first point of contact in booking in its patients and they therefore had the responsibility to provide accurate information as to the availability of medical assistance.

The Supreme Court found that the Court of Appeal failed to distinguish between whether there exists a duty of care and whether there had been a negligent breach of that duty of care.

It expressed its view that finding that this duty exists is not a new head of liability for NHS Trusts and that the ‘undesirable consequences’ had been overstated, though it acknowledged that the very difficult circumstances under which A&E departments operate might be highly influential in the Court’s decision as to whether there has been breach of duty.

It found that a receptionist had a duty of care not to provide misleading information and that the standard required was of “an averagely competent and well-informed person performing the function of a receptionist…” in an A&E department.

The law does not require the healthcare provider to give accurate timings in A&E but must take reasonable care not to give misleading or incorrect information to the patient.

Based on the findings of the first instance trial judge, namely that the information provided was incorrect and that it was reasonably foreseeable that having been given misleading and incorrect information the patient would leave the department, the Supreme Court found that there was a negligent breach of duty by the reception staff and found that the Appellant would have avoided his injuries but for the negligence.

What this means for healthcare providers?

The Court accepts that those working within an A&E department are under significant pressure and that it is difficult to operate in such circumstances. It has however clarified the law that hospitals, through their receptionists or other clerical staff, do owe a duty of care to patients to provide accurate information regarding the provision of medical care, which extends to information regarding waiting times in A&E. Such staff need to be trained as to the protocol for triage and must take reasonable care when providing such information to patients.

The Supreme Court has stated that the burden of proof will still be on the Claimant to evidence that incorrect or misleading information was provided. In such circumstances, the hospital staff will provide evidence as to their specific recollection if they have one or their usual practice when such an injury presents. The Court states that these will be “effective control factors” in limiting the claims made by patients in such circumstances.

Useful links

The Press Summary to the Supreme Court judgment can be found by clicking here.

Should you wish to discuss this matter further, please contact a member of our Healthcare team.